Center on Systems, Outcomes, and Quality in Chronic Disease & Rehabilitation, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI 02908, USA.
Am J Manag Care. 2011 May;17(5):319-28.
To determine whether trends in psychological distress exist in the United States and whether trends in healthcare expenditures and outpatient visits were associated with psychological distress.
Sequential cross-sectional study of nationally representative data.
We examined data from the National Health Interview Survey (NHIS) from 1997 to 2004 linked to 2 years of subsequent Medical Expenditure Panel Survey (MEPS) data. Psychological distress was measured in the NHIS using the K6, a 6-item scale of the Kessler Psychological Distress Scale, which we classified as no/low, mild-moderate, or severe. We examined subsequent annualized total, outpatient, and office-based expenditures, and outpatient and office-based visits from MEPS.
Psychological distress remained stable from 1997 to 2004. There were upward trends in overall healthcare expenditures (P <.001) and outpatient expenditures (P <.001), but not outpatient visits. Overall healthcare expenditures, outpatient expenditures, and outpatient visits significantly increased as psychological distress increased from no/low to mild-moderate to severe. The interaction between psychological distress strata and year was not significant for expenditures or for visits.
The upward trend in total and outpatient healthcare expenditures in the United States appears unrelated to psychological distress, although healthcare expenditures are consistently higher among those with greater psychological distress. Future work will explore the impact of treatment on costs and stability of the nation's mental health over time.
确定美国是否存在心理困扰趋势，以及医疗保健支出和门诊就诊量的变化是否与心理困扰相关。
对全国代表性数据进行的连续横断面研究。
我们研究了 1997 年至 2004 年期间国家健康访谈调查（NHIS）的数据，这些数据与随后 2 年的医疗支出调查（MEPS）数据相链接。NHIS 中使用 K6 量表来衡量心理困扰，这是 Kessler 心理困扰量表的 6 项指标，我们将其分为无/轻度、中度/重度。我们考察了 MEPS 中随后每年的总支出、门诊支出和门诊就诊量、以及门诊和门诊就诊次数。
1997 年至 2004 年期间，心理困扰一直保持稳定。总医疗保健支出（P <.001）和门诊支出（P <.001）呈上升趋势，但门诊就诊量没有增加。从无/轻度到中度/重度，整体医疗保健支出、门诊支出和门诊就诊量都显著增加。心理困扰程度的分层与年份之间的交互作用对支出或就诊次数都没有显著影响。
美国总医疗保健支出和门诊支出的上升趋势似乎与心理困扰无关，尽管在有更严重心理困扰的人群中，医疗保健支出始终更高。未来的研究将探讨治疗对成本的影响以及随着时间的推移国家精神卫生状况的稳定性。
